To File a Standard Appeal

You can file an appeal within 30 days from the date you receive a notice stating that your services were denied. You can file by calling or writing. If needed, we can help you file your appeal. You can also get help from others. Your provider or someone else you chose to act for you can help. They can file for you, if you give them your written permission.

Call Customer Service at 1-888-846-4262 (TTY/TDD: 1-877-247-6272) weekdays, 7:45am to 5:30pm HST, excluding holidays. Or write to us at:

‘Ohana Health Plan

Attn: Appeals Department

P.O. Box 31368

Tampa, FL 33631-3368

To File an Expedited Appeal

You can ask for a fast appeal when your doctor says it is needed. Also, the Plan must believe that the standard appeal time may be harmful to your health. You or your provider must call or fax us to ask for a fast appeal. Call 1-888-846-4262 (TTY/TDD: 1-877-247-6272). Fax to 1-866-201-0657. For fast appeals, we will call you. We will also send a letter with the appeal decision within 3 days.

If you need to get more information for the appeal, you can ask for more time. You can ask for up to 14 more days.

If you ask for a fast appeal and we decide that one is not needed, we will:

• Transfer the appeal to the timeframe for standard resolution
• Make reasonable efforts to try to call you
• Follow up within 2 days of written notice
• Inform you orally and in writing that you may file a grievance for the denial of the expedited process

Click here to submit an appeal

To File a Grievance

A grievance is when you call or write to complain about a provider, the Plan and/or service. Issues may include:

• Quality-of-care issues
• Wait times during provider visits
• The way your providers or others act
• Unclean provider offices
• Not getting the information you need

A grievance does not include being unhappy with an action that was made by the Plan.

You can file a grievance by calling or writing us. You must do this within 30 days of the date of the event you are complaining about. Call Customer Service at 1-888-846-4262 (TTY/TDD: 1-877-247-6272). Or write to:

‘Ohana Health Plan

Attn: Grievance Department

P.O. Box 31384

Tampa, FL 33631-3384